Elephant in the room-will definitely be obvious, but not to the person who do not know an elephant is, or who sincerely able to ignore the elephant. Or maybe the elephant is too small, or the room is too big?

Last week is my first week back to the Clinical with my new post as the Clinical Lecturer and a Paediatrician here in UKMMC. Mixed feeling of excitement and fear,but overall is a wonderful feeling. On the first day itself I was put oncall, and so far Alhamdulillah, it has been okay, while I am adjusting to my current seat.
It was yesterday, during my second oncall at the General and PICU/PHDU side, the event took place. Part of my oncall job is to review all the new admissions on that day and to review all patients in high dependency ward and the ICU. It was a Sunday afternoon,and I guess I am partly in my casual weekend mode.
Joyce, my Registra brought me to a cranky Chinese Boy who was about 7 years old, admitted due to a bad infection of Streptococcal Pneumonia complicated with effusion. He was initially admitted to a Private Hospital but was transferred here for continuing of care. By this time, he was already out of the woods, with only antibiotic and oxygen supplement on board. Despite that, he still remains cranky due to the harsh experience of his earlier stay.

As I approached him, he was inspecting me through one corner of his eyes, thoroughly picking any signs of "danger" I may bring. Realizing that, I stopped and smile while took a step back, and talk to the mother. It took him about a minute or so for him to approved my presence, yet he still know I am a Doctor and I will "disturb" him in some way, despite how mild and kind it will be. So being a kid, he started to complain to the mother of being itchy at the chest, wanting the mother to scratch here and there.
Part of my four years training was learning how to captivate a child. It is an skill, and skill comes with practice and a bit of wisdom. With some "funny" body language and tilting of head with some face grimaces, the boy reluctantly allow me to do my job of examine him. After doing part of my peripheral examination, I took my stethoscope to auscultate the lung.
"Vrup,dap, vrup,dap, vrup, dap" was what I heard and it put me back. I lifted the stethoscope diaphragm and move to the other site of the chest, and what I heard was a more intense similar sound with different variables. It put me to a stop. I looked at Joyce across the bed trying to non verbally communicate with her on my "finding". Obviously, she looked back at me, puzzled.
Hurriedly, I flipped through the folder, while asking my other MOs, "Is there some heart lesion?". Joyce still with her puzzled face asked me why. "There is a weird murmur, you are sure he do not have a heart problem before?, I asked her back. Her puzzled face turned shocked and with that I gave my stethoscope to her and carefully put my diaphragm on the boy's chest for her to listen to what I heard.
She was initially shocked and I let her indulged in it, while looking at the patient's note. About a minute after that, she came to me and said slowly..."Adli, I think what you hear is not really a murmur...I think it is the mother's scratching".
I looked back to the boy directly, and there it was. The mother who was sitting at the side of the child, was diligently scratching her beloved son as initially requested by him. With that, I walked back to him, and asked the mother to stop doing what she was doing, and wallaa.....the so called "murmur" were gone. I smiled to Joyce, signalling her she was right and as we moved to PICU, we laughed on how "stupid" the incident was, and how ignorance I was.

As I was driving back home after the round-it tickles me, how we tend to ignore the obvious. My incidence was a sincere and honest response, and it was mainly because I was shocked with the bad finding despite a relatively healthy child. Yet, I bet, there are lot more moments where we tend to ignore the obvious. I always taught my students to look for obvious sign to explain the situation, and there I was, doing exactly opposite of what I taught. Despite it is not true in this case, usually we tend to ignore the obvious because we want to believe in it, we want it to be in that way. It is different from ignoring the truth, cause in ignoring the obvious-the person sincerely do not realised the obvious.
I was wondering how things ever happened when it is so obvious? But I guess it explains by itself when you basically the one in the shoe of ignorance.